Bronchodilator Responsiveness and Airflow Limitation Are Associated With Deployment Length in Iraq and Afghanistan Veterans

Falvo, Michael J.; Abraham, Joseph H.; Osinubi, Omowunmi; Klein, Jacquelyn C.; Sotolongo, Anays; Ndirangu, Duncan; Patrick-DeLuca, Lydia A.; Helmer, Drew A.

doi:10.1097/jom.0000000000000675

Cited by 15 publications

(7 citation statements)

References 28 publications

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“…23,24 Two prospective studies of returning military personnel primarily identified asthma and non-spe-cific airway hyperreactivity as the primary respiratory disorder in their study populations. 3,25 Longer deployments were associated with increased bronchodilator responsiveness, with a trend toward increased air-flow limitation. 25 As part of the 2011 Department of Defense/Veterans Affairs Airborne Hazards workshop on spirometry, the following recommendation was made by Department of Defense representatives and have been confirmed by this study: "Department of Defense policy at present should not require routine surveillance spirometry in all military personnel.…”

Section: Discussionmentioning

confidence: 99%

“…3,25 Longer deployments were associated with increased bronchodilator responsiveness, with a trend toward increased air-flow limitation. 25 As part of the 2011 Department of Defense/Veterans Affairs Airborne Hazards workshop on spirometry, the following recommendation was made by Department of Defense representatives and have been confirmed by this study: "Department of Defense policy at present should not require routine surveillance spirometry in all military personnel. The burden of evaluating asymptomatic personnel with pulmonary function testing abnormalities would outweigh any benefit from early disease detection.…”

Section: Discussionmentioning

confidence: 99%

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Study of Active Duty Military Personnel for Environmental Deployment Exposures: Pre- and Post-Deployment Spirometry (STAMPEDE II)

et al. 2019

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BACKGROUND: There is significant concern about the respiratory health of deployed military service members given the reported airborne hazards in southwest Asia, which range from geologic dusts, burn pit emissions, chemical exposures, and increased rates of smoking. There has been no previous comparison of pre-and post-deployment lung function in these individuals. METHODS: Military personnel who deployed to southwest Asia in support of ongoing military operations were recruited from the Soldier Readiness Processing Center at Fort Hood, Texas, from 2011 to 2014. The participants were asked to complete a brief survey on their respiratory health and perform both spirometry and impulse oscillometry studies at baseline with repeated survey and testing after deployment. RESULTS: Of the 1,693 deployed personnel who completed baseline examinations, 843 (50%) completed post-deployment testing. Post-deployment values demonstrated no statistical or clinical change in spirometry, with an increase in mean ؎ SD FEV 1 (% predicted) from 95.2 ؎ 12.6 to 96.1 ؎ 12.4 (P ‫؍‬ .14), increase in mean ؎ SD FVC (% predicted) from 95.9 ؎ 11.8 to 96.4 ؎ 11.9 (P ‫؍‬ .32), and increase in mean ؎ SD FEV 1 /FVC from 81.5 ؎ 5.9 to 81.8 ؎ 6.1 (P ‫؍‬ .29). Impulse oscillometry values showed statistical improvement with reduction in resistance (at 5 Hz and 20 Hz) and reactance (at 5 Hz). The presence of pre-deployment obstruction, self-reported asthma, smoking history, or increased body mass index also did not change spirometry values after deployment. DISCUSSION: To our knowledge, this was the first prospective evaluation of deploying military by using spirometry as an indicator for the possible development of pulmonary disease related to environmental exposures. Pre-deployment testing with spirometry and impulse oscillometry was unable to detect any significant change. In those with abnormal spirometry pre-deployment or asthma history, there was also not identifiable change that indicated worsening lung function. CONCLUSIONS: Utilization of spirometry for the deploying military population had little benefit and did not identify individuals with lung disease after deployment. Routine use was not warranted before or after deployment in the absence of pulmonary symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Study of Active Duty Military Personnel for Environmental Deployment Exposures: Pre- and Post-Deployment Spirometry (STAMPEDE II)

et al. 2019

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“…Among 124 veterans referred for evaluation to the New Jersey (NJ) WRIISC (both with and without respiratory symptoms), 26% had a positive bronchodilator response measured in spirometry. This was positively associated with deployment length, adjusted for smoking history ( 84 ). In a subsequent description of 138 veterans evaluated at the NJ WRIISC, 74.6% had normal pulmonary function, 19.6% had an obstructive deficit, and 5.8% had a restrictive deficit.…”

Section: Findings In Clinical Assessments Of Previously Deployed Milimentioning

confidence: 99%

Respiratory Health after Military Service in Southwest Asia and Afghanistan. An Official American Thoracic Society Workshop Report

Garshick¹,

Abraham²,

Baird³

et al. 2019

Annals ATS

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Since 2001, more than 2.7 million U.S. military personnel have been deployed in support of operations in Southwest Asia and Afghanistan. Land-based personnel experienced elevated exposures to particulate matter and other inhalational exposures from multiple sources, including desert dust, burn pit combustion, and other industrial, mobile, or military sources. A workshop conducted at the 2018 American Thoracic Society International Conference had the goals of: 1 ) identifying key studies assessing postdeployment respiratory health, 2 ) describing emerging research, and 3 ) highlighting knowledge gaps. The workshop reviewed epidemiologic studies that demonstrated more frequent encounters for respiratory symptoms postdeployment compared with nondeployers and for airway disease, predominantly asthma, as well as case series describing postdeployment dyspnea, asthma, and a range of other respiratory tract findings. On the basis of particulate matter effects in other populations, it also is possible that deployers experienced reductions in pulmonary function as a result of such exposure. The workshop also gave particular attention to constrictive bronchiolitis, which has been reported in lung biopsies of selected deployers. Workshop participants had heterogeneous views regarding the definition and frequency of constrictive bronchiolitis and other small airway pathologic findings in deployed populations. The workshop concluded that the relationship of airway disease, including constrictive bronchiolitis, to exposures experienced during deployment remains to be better defined. Future clinical and epidemiologic research efforts should address better characterization of deployment exposures; carry out longitudinal assessment of potentially related adverse health conditions, including lung function and other physiologic changes; and use rigorous histologic, exposure, and clinical characterization of patients with respiratory tract abnormalities.

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“…Barth et al suggested an increase in reported respiratory disease with respiratory exposures (eg, exposure to dust, smoke, chemicals, and pollutants) . In studies supporting the development of respiratory disease after deployment, the most commonly cited risk factors were duration of deployment and number of deployments . Other associations include exposure to chemical fires, incineration of human and solid waste, dust storms, and combat smoke …”

Section: Impact On the Lower Respiratory Tractmentioning

confidence: 99%

Combat zone exposure and respiratory tract disease

Parsel

Riley

McCoul

2018

Int Forum Allergy Rhinol

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Bronchodilator Responsiveness and Airflow Limitation Are Associated With Deployment Length in Iraq and Afghanistan Veterans

Abstract: In our sample of post-9/11 veterans, longer deployment lengths were associated with significant bronchodilator responsiveness and a trend toward airflow limitation independent of tobacco use.

Cited by 15 publications

References 28 publications

Study of Active Duty Military Personnel for Environmental Deployment Exposures: Pre- and Post-Deployment Spirometry (STAMPEDE II)

Study of Active Duty Military Personnel for Environmental Deployment Exposures: Pre- and Post-Deployment Spirometry (STAMPEDE II)

Respiratory Health after Military Service in Southwest Asia and Afghanistan. An Official American Thoracic Society Workshop Report

Combat zone exposure and respiratory tract disease

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